Clinical documentation integrity is a keystone for data quality and ultimately, claims reimbursement. One western health care system identified an increase in their clinical denials that resulted from insufficient clinical documentation and decided to do something about it.

The health system was dealing with a shortage of resources to manage their CDI program, lacked education for their physicians regarding documentation and experienced decreased specificity in their coding which led to compromised revenue.

The 555-bed health care system collaborated with the nThrive CDI Specialist team and, within 6 months, realized $420K ROI, plus improved credibility and stronger intercommunications between CDI staff, medical coders and health care providers.

How they did it

During the proof of concept, the nThrive CDI team reviewed charts concurrently and initiated CDI physician queries, and opportunities for physician education during monthly meetings with the health system’s MICU, SICU, PICU and NICU, which led to the significant ROI gain. The proof of concept resulted in an extension of the engagement, including advisory, functional and managerial CDI services.

From February to December 2019, the program has evolved further as the two teams:

  • Expand reviews that include surgical patients
  • Initiate queries for quality and financial benefit, plus increase severity of illness and risk of mortality
  • Initiate queries to obtain additional documentation, optimizing DRG assignment, resulting in increased LOS
  • Create and provide education based on auditing results
  • Serve as second reviewer on mortality, PSI and HAC cases

All these improvements resulted in another strong value; the health system has added 221 days to LOS for impacted cases or 2.76 days per case.

"… We are experiencing higher levels of accurate coding and billing. (The real-time feedback from nThrive) improved documentation and helped build credibility and improve communications between CDI specialists, coders and providers." - Director of Inpatient Pediatrics

Read on to discover how the CDI team transformed their CDI software program.